In line with AHRQ's mission to improve the quality, safety, efficiency, and effectiveness of health care, the goal of this research is to develop decision support tools that integrate with electronic health record systems (EHR) to increase the quality and effectiveness of chronic pain care. This study is responsive to AHRQ Program Announcement 11-198 and most relevant to interest area 2, the nature of clinical expertise in individual and team decision making. Overall, the study will accomplish three objectives. First, the study will describe primary care clinician patterns in information availability, use, and care planning during patient visits for chronic non-cancer pain. Second, the study will identify gaps in care between actual practice and clinical practice guideline recommendations. Finally, based on this understanding of how clinical work happens and could be improved, the study will design and test new decision support tools to improve pain care. Specific Aim 1: Characterize primary care clinicians' information use and decision making patterns during patient visits for musculoskeletal pain to determine how they align with clinical practice guidelines. Data will be collected from medical records, visit audio recordings, and post-visit clinician interviews for up o 125 patient visits. Data will then be qualitatively analyzed to cluster visits into similar sensemaking narratives and used to identify commonly-occurring missed opportunities in which decision support could have altered the use of clinical information or altered care plan choices to better align with guideline recommendations. Specific Aim 2: Based on the sensemaking narratives and missed opportunities identified in Aim 1, prototype and preliminarily evaluate new decision support designs to meet clinicians' information needs and guide them toward guideline-based information use and care choices. This aim will involve a three-day design workshop and usability testing with engineers, clinicians, and patients to produce prototypes for novel, guideline-based decision support systems that can be integrated in EHRs. This innovative project will be the first to conduct in-depth analysis of patient visits, clinician interviews, and medical record data to understand primary care clinical decision making for chronic pain. Moreover, this knowledge will be used to produce new EHR-based decision support tools that help clinicians provide the best care possible and improve the lives of the millions of Americans who suffer from chronic pain.